Title Page
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Conducted on
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A55 Prepared by
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Location
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Build Town
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PDP Number
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A55 ID
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Chamber/Pole Reference
A55 Detail
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Chamber/Pole 1 Description
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Chamber/Pole 1 Location
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Chamber/Pole 2 Description
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Chamber/Pole 2 Location
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Section Length
Blockage
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Surface Type
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Distance from Chamber 1
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Photo of Rod in Chamber 1 Bore
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Distance from Chamber 2
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Photo of Rod in Chamber 2 Bore
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Photo of Sprayed up Blockage
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Duct Reference (BT Portal)
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X and Y Co-ordinates
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Is TM Required?
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TM Type
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Is the duct section on a red route or bus lane
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Is the duct section on a cycle lane
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Number of Bores
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Number of Cables currently in bore
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Current capacity of bore (% full)
Pole Bend
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Surface Type
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Distance from Chamber 1
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Photo of Rod in Chamber 1 Bore
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Distance from Pole
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Photo of Rod in Pole Bend if Possible
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Photo of Sprayed up Blockage
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Duct Reference (BT Portal)
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X and Y Co-ordinates
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Is TM Required?
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TM Type
Track
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Surface Types:
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Soft Length
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Photos
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Is TM Required?
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TM Type
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Footway (Tarmac) Length
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Footway (Modular) Length
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Carriageway (Tarmac) Length
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Carriageway (Modular) Length
